Provider Demographics
NPI:1619082831
Name:OFFICE PARK DIAGNOSTICS
Entity Type:Organization
Organization Name:OFFICE PARK DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-277-2873
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:B195
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-277-2873
Mailing Address - Fax:859-278-5758
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:B195
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-277-2873
Practice Address - Fax:859-278-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY160531261QR0200X
KY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000073085OtherBLUE CROSS BLUE SHIELD
KY65916983Medicaid
KY000000061988OtherBLUE CROSS BLUE SHIELD
KY37901881Medicaid
KYCN1524OtherRAILROAD MEDICARE
KY0223101Medicare ID - Type Unspecified
KY2231Medicare PIN
KY37901881Medicaid